Analysis Of Short-term Efficacy Of Laparoscopy-asssisted Total Gastrectomy In Elderly Patients With Gastric Cancer

Objective:To explore the limitation,safety and feasibility of laparoscopy-asssisted total gastrectomy with D2 in elderly patients with gastric cancer.Methods:Retrospectively reviewed the perioperative clinical data of patients over the age of 70 with gastric cancer who were treated by radical total gastrectomy with D2 in the Gastrointestinal Surgery Department of Fujian Provincial Cancer Hospital from January 2010 and December 2016.According to the inclusive and exclusive criterias,study enrolled 212 patients.Patients were divided into two groups by different sugical methods:LATG(laparoscopy-asssisted total gastrectomy)group(60 cases)and OTG(open radical total gastrectomy)group(152 cases).In the two groups,the differences of several materials were analyzed,such as the time-consuming and volum of blood loss in operation,radical resection of tumer,postoperative recovery and postoperative complications,after comparing preoperative situation,tumor location and tumor preoperative clinical staging of patients.Results : This study showed that the time-consuming of LATG group was 245(208.25-300.75)min which was significantly longer than 175.5(150-206)min of OTG group(P<0.01).However,there was not significant difference between LATG group and OTG group in term of the volum of blood loss(226.52±137.17 ml vs 213.56±113.06 ml,P>0.05).No significant differences were observed between the two groups in terms of the distance of proximal and distal margin,the number of lymph nodes dissection,the time of returning to first liquid diet and rates of postoperative complications(P>0.05).The length of the incision of LATG group was 9(8-9.75)cm which was shorter than 21(20-21)cm of OTG group significantly(P<0.01),and LATG could make full use of the four holes of placing trocars on either side of the abdominal wall,avoiding further damage and embodying obviously its minimally invasive effect.The postoperative exhausting time,the time of removing peritoneal drainage tube and the postoperative hospital stay in LATG group were respectively(4.05±1.69)d,(7.93±3.88)d and(13.53±4.07)d,which were all shorter than(4.66±1.87)d,(9.79±6.36)d,(15.35±6.49)d in OTG group.Conclusion:Although laparoscopy-asssisted total gastrectomy with D2 increases surgical time-consuming,it shows shorter incision,earlier postoperative exhaust,earlier removing peritoneal drainage tube,as well as shorter postoperative hospital stay,conforming to the principle of radical resection of tumer,without increasing volum of blood loss and and the rates of postoperative complications.This analysis indicates that laparoscopy-asssisted total gastrectomy with D2 is really secure and feasible for elderly patients with gastric cancer.